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| Assessment and Diagnosis of ADHD in the Child or Adolescent How Do We Diagnose ADHD in Children and Adolescents? At this time there are no blood tests or any one definitive test that confirms a diagnosis of ADHD. Every child or adolescent entering a doctor's office presenting with symptoms of inattention, impulsiveness and/or hyperactivity does not immediately qualify for a diagnosis of ADHD. The diagnosis of ADHD is a process of ruling out other possible conditions that could account for these symptoms and confirming that the symptoms that are present truly fit an ADHD diagnosis. For this reason, accessing an experienced physician who knows how to do a thorough ADHD assessment through observation and testing is very important. What is Involved in a Thorough Assessment? A thorough assessment by the physician should include many components. It should begin with a complete medical history and physical, including some type of screening to rule out any possible physical disorders such as a thyroid disorder. A vision assessment that looks at perceptual problems and not just if the child is seeing well is also important, especially if the child is having problems with reading. A complete hearing assessment, including a central auditory assessment can tell us if the child or adolescent is actually understanding what they are hearing and not just if they are able to hear. Who Can and Should Diagnose ADHD? An assessment can be done by a psychiatrist, pediatrician, psychologist, neurologist or a family doctor. In many cases more than one professional will be needed to complete a thorough assessment. Since making a diagnosis is not a simple procedure, it is recommended that you find a professional, or perhaps more than one professional, who has some experience in this field. If this is not possible due to your location, your physician may find the information in the CADDRA ADHD Practice Guidelines available on the CADDRA web site http://www.caddra.ca/english/phys_guide.html helpful. Do not hesitate to ask professionals who you are considering using, how many children with ADHD they routinely assess and treat, what type of assessment they do and how they normally handle treatment options, report-writing and follow-up. Asking other parents and professionals who have dealt with ADHD for recommendations can also be helpful. The Use of ADHD Rating Scales The diagnosis of ADHD is based upon the ability to observe symptoms that seem to occur consistently enough that they could not be a coincidence. Since there is no accurate way to evaluate the level of inattention, hyperactivity and impulsivity, the physician or psychologist will use symptom rating scales that will help him or her to diagnose the disorder with some level of certainty. These scales will compare your child's level of behavior with what is considered average for a child of his/her age. There is of course, a wide range of levels that is considered within the average range. Your child's teacher will also be asked to complete similar rating scales. This will help to compare your child's functioning in a classroom setting with their functioning at home. It is often in the school environment where symptoms of attention, hyperactivity and impulsivity stand out the most. Academic problems and problems with productivity and procrastination can also be an indication that the student may be experiencing problems with attention and focus. Symptoms of ADHD need to be seen and documented in two different environments for ADHD to be diagnosed. DSM IV-TR List of Symptoms The DSM-IV or 'Diagnostic and Statistical Manual', produced by the American Psychiatric Association, lists 9 symptoms of inattention and 9 symptoms of impulsivity and hyperactivity. If the child displays 6 out of 9 symptoms in these lists, in two environments, for the last 6 months and has an onset of the symptoms before the age of 7 - they are considered to have ADHD. However, there also needs to be clear evidence that the symptoms cause impairment and cannot be better explained by another mental disorder. The subclassification of the child's ADHD will depend of which of the two lists the child rates 6 out of 9 symptoms in. A child who reaches the criteria in the section on inattention only, will be diagnosed with the primarily inattentive subtype. If however, the criteria of both sections are reached the diagnosis would be, ADHD combined subtype. The diagnosis of primarily hyperactive/impulsive subtype would be reached in the same way. (For an explanation of subtypes access Types of ADHD) To view the list of symptoms in the DSM IV-TR access: http://www.help4adhd.org/en/treatment/guides/dsm. What Else Will the Person Assessing my Child Need to Know? Most physicians will use a combination of rating scales filled in by parents and teachers using the DSM-IV as a guideline. An extensive interview with the child and parents should also occur in order to confirm the level of impairment these symptoms cause. The physician will require information on your family. Looking at how the family functions and taking a history of any mental health problems in the immediate and extended family will help the physician to get an accurate picture of the child's environment and genetic make-up. This will help to access any possible contributing factors. The physician and any other professional assessing your child will need to know if there were any problems during the pregnancy or birth. They will also be interested in looking at the early days of the child's life. This information will help to rule in or out any contributing environmental causes of ADHD. |